For critically ill patients requiring continuous renal replacement therapy, regional citrate anticoagulation is the preferred strategy to maintain extracorporeal circuit patency. Current clinical practice relies on two citrate-based protocols, with the widely used but complex 4% trisodium citrate solution posing a hypernatraemia risk and haemofiltration replacement fluid of sodium citrate offering procedural simplification and a more physiological electrolyte profile. Direct prospective comparison of their circuit lifespan efficacy is currently unavailable.

This single-centre, prospective, open-label, parallel-group randomised controlled trial will be conducted in China. 90 patients will be enrolled and randomly assigned (1:1) to receive anticoagulation with either citrate-based haemofiltration replacement fluid or 4% trisodium citrate solution, with all patients undergoing a standardised continuous venovenous haemofiltration protocol. The primary outcome is circuit lifespan, with a non-inferiority margin set at 2.43 hours. Secondary outcomes include the 72-hour circuit survival probability, duration of hospitalisation, and all-cause mortality rates at 28 and 90 days. The primary analysis will follow the intention-to-treat principle.

The study protocol has been approved by the Biomedical Research Ethics Committee of West China Hospital, Sichuan University (Approval No. (2025)1157). Any subsequent amendments must be submitted to the same ethics committee for further review and approval prior to implementation. Furthermore, the findings of this trial will be disseminated through presentations at relevant national and international conferences and via publication in peer-reviewed scientific journals.

Chinese Clinical Trial Registry ChiCTR2500106991.

The purpose of this study was to investigate the factors influencing life satisfaction in patients with chronic kidney disease and to explore any sex differences. Thus, this provides a theoretical basis for improving the life satisfaction status of middle-aged and elderly patients with chronic kidney disease, as well as formulating prevention, treatment and intervention strategies.

Based on the health ecology model, 22 potential influencing factors were identified at five levels. Subsequent analyses examined whether they impacted the life satisfaction of patients with chronic kidney disease and had varying effects on different sexes.

A total of 1422 patients with chronic kidney disease were included from the 2018 China Health and Retirement Longitudinal Study.

The ² test and multivariate logistic regression model were used to analyse the influencing factors of life satisfaction in patients with chronic kidney disease and their sex differences. Sensitivity analyses additionally supported the robustness of the results.

Age, self-rated health, depressive symptoms, marital satisfaction, satisfaction with children, activities of daily living and pension were all significant influencing factors of life satisfaction in patients with chronic kidney disease (p

This study reveals that a combination of factors affects life satisfaction in patients with chronic kidney disease. Therefore, targeted prevention and intervention strategies should be carried out, with specific focus on females, individuals with poor self-rated health and those experiencing depressive symptoms from a multidimensional perspective.

Colchicine has been shown to reduce cardiovascular events and may improve outcomes in arteriovenous fistulas used for haemodialysis due to antiproliferative effects. However, it is often avoided in patients receiving dialysis. Therefore, a large trial assessing the potential benefits of colchicine in dialysis patients cannot begin without further data on feasibility. The primary objective of this study is to assess the feasibility of carrying out future trials of colchicine in dialysis patients.

This is an open-label, single centre, single arm study with 100 participants. The primary outcome is feasibility and the decision to progress to a full-scale trial. This will be based on the consent rate and the colchicine discontinuation rate. Secondary objectives are testing the feasibility of data collection procedures relating to quality-of-life measures, vascular access interventions and safety. Other secondary objectives are to assess the utility of the electronic health record for collecting trial data and to explore patients’ and healthcare providers’ experiences and attitudes towards colchicine and a feasibility study.

The study has Research Ethics Committee approval (Wales REC 6; 24/WA/0277). It is intended that the results of the study will be reported in peer-reviewed scientific journals.

ISRCTN91308625.

To investigate the association between longitudinal trajectories of metabolic risk clusters and the risk of progression to end-stage kidney disease (ESKD) and major adverse kidney events (MAKEs) in patients with chronic kidney disease (CKD).

Prospective registry-based cohort study.

Secondary and tertiary care settings in Taiwan, using data from a multidisciplinary pre-ESKD care programme.

A total of 1494 adult patients with CKD stages 3b–5 enrolled in a structured pre-ESKD care programme.

Time to initiation of dialysis (primary outcome) and time to MAKE, defined as a composite of dialysis initiation or all-cause mortality (secondary outcome). Group-based multitrajectory modelling was used to categorise longitudinal trajectories of metabolic risk clusters, including systolic blood pressure, fasting blood glucose and low-density lipoprotein (LDL) cholesterol.

Four trajectory groups were identified: Group I had controlled blood pressure and glucose but elevated LDL (dialysis incidence: 19.5 per 1000 person-years); Group II had borderline-high blood pressure and elevated glucose (33.6 per 1000 person-years); Group III had controlled glucose and low LDL but borderline-high blood pressure (38.8 per 1000 person-years) and Group IV had controlled glucose but elevated blood pressure and LDL (46.7 per 1000 person-years). Compared with the other groups, Group I exhibited significantly longer dialysis-free and MAKE-free survival (log-rank test, p

Longitudinal trajectories of metabolic risk cluster are associated with differential risks of CKD progression to ESKD and death. Our findings provide valuable insights into the monitoring of metabolic risk profiles over time in patients with CKD.

Peritoneal dialysis (PD) is a widely used renal replacement therapy for chronic kidney disease patients, yet malnutrition remains a common complication linked to poor outcomes. Nearly 40% of PD patients in China are malnourished, with serum albumin levels below 35 g/L. Amino acid-based peritoneal dialysis solutions (AA-PDS), which replace glucose with amino acids as the osmotic agent, have been used globally for decades to improve nutrition and reduce peritoneal damage, but they were introduced to mainland China only in 2022. This study aims to evaluate the efficacy and safety of AA-PDS in improving nutritional status and clinical outcomes among malnourished PD patients in mainland China, providing a potential new therapeutic option for this population.

This multicentre, open-label, prospective, parallel-controlled study will enrol patients with end-stage kidney disease who were stable on PD for more than 3 months. A total of 500 eligible patients will be divided into the intervention group undergoing PD once every morning using 2.0 L of amino acid (15) PD solution and the control group using conventional PD solution (lactate) in a 4:1 ratio based on their willingness and clinical needs. Our primary outcome is serum albumin, while other nutritional indicators, including serum prealbumin, serum transferrin, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and ultrafiltration volumes are considered secondary outcomes. Information such as demographics, clinical and biochemical characteristics, examination indicators, anthropometry measurements and Subjective Global Assessment scores will be collected at baseline, 1 month, 3 month and 6 month follow-up. Statistical analysis will be conducted using SAS V.9.4 or higher versions. All statistical tests are conducted through the two-tailed test, and a p value≤0.05 will be considered statistically significant. The description of quantitative indicators will be used in calculating the number of cases, mean, SD, median and IQR method. The classification indicators will be used to describe the number of cases and percentages (frequency and frequency rate).

This multicentre study obtained ethical approval from the lead ethics committee at the First Affiliated Hospital of Zhejiang Chinese Medical University (approval no.: 2024-KLS-379-02). Additionally, each participating site provided local ethical approval or a formal waiver, as required by their institutional policies. The results will be reported in a peer-reviewed journal and a relevant academic conference.

ChiCTR2400090896.

Sodium-glucose cotransporter (SGLT) inhibitors have shown substantial benefit in reducing cardiovascular and kidney events across diverse clinical populations, but the underlying physiological mechanisms remain unclear. However, existing mechanistic studies on renal and cardiovascular haemodynamics show variability in design, have limited statistical power and yield inconsistent outcomes, thus limiting the ability to draw generalisable conclusions. To address this gap, we conducted a systematic review and proposed the first meta-analysis to aggregate individual participant-level data from mechanistic studies to identify consistent physiological patterns and enhance understanding of the therapeutic effects of SGLT inhibition.

Gold-standard measured glomerular filtration rate (mGFR) was selected as the primary outcome for this systematic review, which aimed to identify all completed mechanistic studies investigating the effects of SGLT inhibition. Electronic databases including Ovid MEDLINE; Ovid Embase; Cochrane Database of Systematic Reviews; and Cochrane Central Register of Controlled Trials were searched using a detailed search strategy. In total, 24 studies (n=1296) were identified. This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Key variables including demographics, medical history, concomitant medications, vital signs, mGFR, renal haemodynamics, urine and plasma biochemistry, tubular sodium handling, echocardiography, cardiac output monitoring, arterial stiffness and fluid volume will be extracted. A one-stage individual participant data meta-analysis under a Bayesian framework will be conducted, using hierarchical models to simultaneously analyse data from all eligible studies. The risk of bias due to missing results will be assessed. Sensitivity analyses and subgroup evaluations will be incorporated to explore sources of heterogeneity and assess robustness of findings.

Ethics approval was obtained from University Health Network, Toronto, Canada. Findings from the Mechanisms of SGLT Inhibitor Action and Physiological Mediators (MOSAIC) meta-analysis will be published in peer-reviewed journals and results will be disseminated at scientific conferences.

CRD420251001413.

To assess the incidence and risk of major adverse cardiovascular events (MACE) in patients with different stages of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) in Taiwan.

Retrospective cohort study.

Secondary and tertiary care; data were collected from three affiliated hospitals in northern Taiwan.

A total of 7038 adult patients with clinically confirmed CKD stages 3–5 were included, of whom 14.09% had progressed to ESKD. Patients were identified from a multicentre database in northern Taiwan. Key exclusion criteria included age under 20 years, prior MACE, cancer or renal transplantation.

The primary outcome was the incidence of MACE during follow-up. Secondary analyses included time to MACE and subgroup comparisons by CKD stage and comorbid conditions (eg, diabetes, cardiovascular disease).

MACE occurred in 49.8% of patients with CKD and 64.1% of those with ESKD. After adjustment for covariates, the ESKD group had a significantly higher risk of MACE (HR=1.52; 95% CI 1.08 to 2.16) compared with the non-ESKD group. Relative to stage 3a, the adjusted HRs for MACE were 1.13 (95% CI 0.74 to 1.73) for stage 3b, 1.13 (95% CI 0.74 to 1.70) for stage 4, 1.82 (95% CI 1.18 to 2.81) for stage 5 (non-ESKD) and 2.32 (95% CI 1.51 to 3.57) for stage 5D (ESKD). Diabetes and cardiovascular comorbidities were associated with increased MACE incidence and shorter time to MACE, but their associations became non-significant after adjustment.

Based on a multicentre cohort from Taiwan, our findings provide insights into the prognosis of patients with CKD across disease stages and highlight the importance of targeted interventions and integrated care to improve cardiovascular outcomes.

Cardiovascular disease (CVD) is the leading cause of mortality in patients undergoing chronic haemodialysis (HD). However, relatively few data exist regarding the influence of dialysis treatment on cardiac biomarkers such as high-sensitivity cardiac troponin I and T (hs-cTnI and hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), complicating their interpretation in the diagnosis of acute coronary syndrome and heart failure. This study aims to investigate the intradialytic kinetics of hs-cTnT, hs-cTnI and NT-proBNP, during HD and haemodiafiltration (HDF), in patients treated with chronic HD.

Single-centre, randomised, open-label, crossover study, comparing high-flux HD (FX 100 dialyser) and postdilution HDF (FX 1000 dialyser), regarding their potential clearance of hs-cTnI, hs-cTnT and NT-proBNP, in 24 stable patients treated with in-centre HD without acute CVD. The study will investigate changes in concentrations during and after high-flux HD and postdilution HDF and calculate reduction ratios, dialyser clearance and clearance by adsorption to the membrane of the selected cardiac biomarkers. Blood samples will be collected at baseline, after 10, 30, 60, 120, 180 and 240 min of dialysis and 30 min postdialysis. After 120 min of dialysis, dialysate will also be collected from the dialyser outlet line. The primary outcome is change from baseline in concentrations of hs-cTnI, hs-cTnT and NT-proBNP during high-flux HD and postdilution HDF.

The study has been approved by the North Denmark Region Committee on Health Research Ethics (N-20240016). Results will be published in an international peer-reviewed journal and disseminated at national and international research meetings.

NCT06526702.

Acute kidney injury (AKI) is a significant challenge in hospital settings, and accurately differentiating between intrinsic and prerenal AKI is crucial for effective management. The fractional excretion of urea (FEUN) has been proposed as a potential biomarker for this purpose, offering an alternative to traditional markers such as fractional excretion of sodium. This study aimed to assess the diagnostic accuracy of FEUN for differentiating intrinsic from prerenal AKI in hospitalised patients.

We conducted a systematic review and bivariate random effects meta-analysis of diagnostic accuracy studies. The study followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

PubMed, Embase and Cochrane databases were searched from inception to 1 November 2023.

We included observational studies that focused on patient with AKI and reported FEUN data sufficient to reconstruct a complete 2x2 contingency table (true positives, true negatives, false positives and false negatives) for evaluating its diagnostic accuracy.

Two reviewers extracted data, assessed risk of bias with Quality Assessment of Diagnostic Accuracy Studies-2 and graded certainty of evidence using the GRADE approach. Pooled sensitivity, specificity, positive and negative likelihood ratios, and the area under the summary receiver operating characteristic curve (SROC) were calculated; heterogeneity was measured with I². A prespecified subgroup restricted to patients receiving diuretics served as a sensitivity analysis.

12 studies involving 1240 patients were included, with an overall occurrence rate of intrinsic AKI of 38.8%. FEUN had a pooled sensitivity of 0.74 (95% CI 0.60 to 0.84) and specificity of 0.78 (95% CI 0.66 to 0.87), with positive predictive value and negative predictive value of 0.76 (95% CI 0.68 to 0.83) and 0.74 (95% CI 0.66 to 0.81), respectively. The SROC curve showed a pooled diagnostic accuracy of 0.83. Heterogeneity was substantial (I²>90%) for sensitivity and specificity. In a diuretic-only subgroup (six studies) specificity rose to0.87 and heterogeneity declined (I²=56%). Overall certainty of evidence was low owing to inconsistency.

FEUN is a biomarker with moderate diagnostic accuracy for differentiating between intrinsic and prerenal AKI in hospitalised patients. Its application could enhance AKI management; however, the high heterogeneity observed in our study highlights the need for further research to evaluate its utility across diverse patient populations and clinical settings.

CRD42024496083.

Chronic kidney disease (CKD) arises due to uncontrolled hypertension (HTN). HTN significantly increases the risk of complications in vital organs, mainly the kidneys. If hypertensive individuals receive early intervention, the majority of these complications and deaths from CKD can be avoided. Having a clinically applicable tool to predict the future risk of those complications can prevent early disability and premature mortality. However, to this day, there is a lack of a validated risk prediction model specifically designed for CKD of hypertensive patients in Ethiopia. We aimed to develop a risk prediction model for CKD among hypertensive patients at the University of Gondar Comprehensive Specialised Hospital (UoGCSH), Ethiopia.

A retrospective follow-up study was conducted from 1 January 2012 to 30 December 2021. The Least Absolute Shrinkage and Selection Operator regression methods were used to select predictors. The performance of the models was assessed using the Area Under the Curve and calibration plots. The internal validity of the model was evaluated using bootstrapping methods, and the model was presented as a nomogram. Decision curve analysis was conducted to assess the net benefit of the prediction model in clinical and public health contexts.

Data from patients’ medical records were collected via the Kobo Toolbox in the UoGCSH.

We followed a total of 1120 Patients diagnosed with HTN.

The incidence of CKD among adult hypertensive patients was 19.82% (95% CI 17.59% to 22.26%). In the multivariable logistic regression analysis, age, residency, baseline blood pressure status, type of HTN, family history of HTN, baseline serum creatinine levels, proteinuria at baseline and dyslipidaemia were identified as statistically significant predictors of CKD. The nomogram demonstrated a discriminatory power of 91.98% (95% CI 90.09% to 93.88%) and a calibration p value of 0.327. The sensitivity and specificity of the prediction model were 80.63% (95% CI 74.81% to 85.61%) and 87.97% (95% CI 85.66% to 90.03%), respectively. The developed nomogram has a greater net benefit than using the treat-all or treat-none strategies when the threshold probability of the patient is increased.

The nomogram demonstrated excellent discrimination and calibration in identifying hypertensive patients at high risk of CKD. This predictive model offers clinicians a valuable tool for early identification of high-risk individuals, enabling timely interventions, personalised counselling and optimised management through close monitoring to prevent disease progression.

Large differences exist in chronic kidney disease (CKD) rates between countries, but differences within diverse populations living in the same setting with universal healthcare are not well understood.

To compare dialysis prevalence, CKD risk factors and control, and CKD progression by ethnicity and birth country in an ethnoculturally diverse setting with high rates of kidney disease and universal healthcare.

Scarborough, Toronto’s most diverse region and site of Canada’s largest regional dialysis programme.

Double observational cohort study of 2397 participants: a retrospective cohort of 1116 residents who received dialysis between 2016–2019, and a prospective cohort of 1281 individuals with non-dialysis CKD followed for 3 years between 2010–2015 in Scarborough.

Dialysis prevalence, calculated by comparing frequencies of birth countries and ethnicities in the dialysis cohort with census-derived community frequencies. Secondary outcome measurements were traditional CKD risk factor prevalence (diabetes, hypertension, cardiovascular disease) and control (haemoglobin A1c, blood pressure); and CKD progression (estimated glomerular filtration rate decline, proteinuria) adjusted for socioeconomic status in the non-dialysis cohort.

Dialysis prevalence was 4.2 times higher in immigrants (p

Despite universal healthcare access, marked disparities in CKD risks and rates exist within ethnoculturally diverse immigrants living in this Canadian kidney disease hotspot. More focused research and tailored interventions are required.

Process evaluation provides insight into how interventions are delivered across varying contexts and why interventions work in some contexts and not in others. This manuscript outlines the protocol for a process evaluation embedded in a hybrid type 1 effectiveness-implementation randomised clinical trial of incremental-start haemodialysis (HD) versus conventional HD delivered to patients starting chronic dialysis (the TwoPlus Study). The trial will simultaneously assess the effectiveness of incremental-start HD in real-world settings and the implementation strategies needed to successfully integrate this intervention into routine practice. This manuscript describes the rationale and methods used to capture how incremental-start HD is implemented across settings and the factors influencing its implementation success or failure within this trial.

We will use the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) frameworks to inform process evaluation. Mixed methods include surveys conducted with treating providers (physicians) and dialysis personnel (nurses and dialysis administrators); semi-structured interviews with patient participants, caregivers of patient participants, treating providers (physicians and advanced practice practitioners), dialysis personnel (nurses, dieticians and social workers); and focus group meetings with study investigators and stakeholder partners. Data will be collected on the following implementation determinants: (a) organisational readiness to change, intervention acceptability and appropriateness; (b) inner setting characteristics underlying barriers and facilitators to the adoption of HD intervention at the enrollment centres; (c) external factors that mediate implementation; (d) adoption; (e) reach; (f) fidelity, to assess adherence to serial timed urine collection and HD treatment schedule; and (g) sustainability, to assess barriers and facilitators to maintaining intervention. Qualitative and quantitative data will be analysed iteratively and triangulated following a convergent parallel and pragmatic approach. Mixed methods analysis will use qualitative data to lend insight to quantitative findings. Process evaluation is important to understand factors influencing trial outcomes and identify potential contextual barriers and facilitators for the potential implementation of incremental-start HD into usual workflows in varied outpatient dialysis clinics and clinical practices. The process evaluation will help interpret and contextualise the trial clinical outcomes’ findings.

The study protocol was approved by the Wake Forest University School of Medicine Institutional Review Board (IRB). Findings from this study will be disseminated through peer-reviewed journals and scientific conferences.

NCT05828823.

Chronic kidney disease (CKD) affects over 850 million people globally, with nearly 80% residing in low- and middle-income countries (LMICs). Despite this high prevalence, there is limited understanding of health-related quality of life (HRQOL) among patients with CKD in these resource-constrained settings. This systematic review and meta-analysis aims to quantify HRQOL scores across CKD stages and treatment modalities in LMICs.

We will conduct a comprehensive search of electronic databases including PubMed, Medline, Scopus and Web of Science, for observational studies published from January 2000 onwards in English or Russian. Eligible studies will include adult patients (≥18 years) with CKD stages 1–5, those on dialysis or kidney transplant recipients in LMICs. Two independent reviewers will screen studies, extract data and assess methodological quality using the Joanna Briggs Institute critical appraisal checklist. We will perform random-effects meta-analyses to pool HRQOL scores, stratified by CKD treatment groups. Heterogeneity will be assessed using I² statistics, with subgroup analyses and meta-regression conducted to explore potential sources of heterogeneity. The primary outcome will be pooled estimates of HRQOL scores across different CKD stages and treatment modalities in LMICs. Secondary outcomes will include subgroup analyses by income classification, geographical region and CKD stage depending on the availability of the data.

Ethical approval is not required for this study. Results will be submitted to a peer-reviewed, open-access journal and presented at scientific conferences.

CRD420251016382.

To describe screening programmes for early chronic kidney disease (CKD) in the USA and other English-speaking countries (Canada, Australia and UK) involving patients with diabetes or hypertension, in addition to high-risk racial or ethnic groups.

Systematic literature review.

Embase and MEDLINE (both via Ovid) between 1 January 2018 and 17 October 2023.

CKD screening programmes in patients with diabetes and/or hypertension in the targeted countries were included.

Publications meeting the review objectives and prespecified population, intervention, comparator, outcome and eligible study design types were identified. Full-text publications were assessed for quality by two independent reviewers. For randomised controlled trials, quality/risk of bias (ROB) was assessed using version 2 of the Cochrane ROB tool for randomised trials; for observational longitudinal or prospective studies and non-randomised trials, quality/ROB was assessed using the Newcastle-Ottawa Scale.

Of 5542 records identified from database searches, 21 studies were included. Of these, the majority (13 studies) screened patients with diabetes and/or hypertension. Screening programmes were described in 16 studies; the remaining 5 reported CKD prevalence. Of 30 643 162 pooled participants, 6 413 466 (weighted mean: 21%) received complete screening for CKD (ie, evaluation of albumin-to-creatinine ratio plus estimated glomerular filtration rate). The weighted mean prevalences of any type of CKD testing in patients with diabetes or hypertension were 33% and 12%, respectively. For the pooled population of 24 608 indigenous persons or underserved communities, the weighted mean prevalence of CKD screening was 91%. Weighted mean prevalences for any type of CKD testing were 22% (n=30 705 837) in primary care and 93% (n=26 640) in community outreach settings. Follow-up testing was infrequent or not reported in most studies.

These findings indicate a low prevalence of CKD screening of high-risk patients, particularly in primary care. Contrary to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, most high-risk patients studied received incomplete screening. Lack of adherence to KDIGO guidelines on CKD screening may result in delays in CKD diagnosis and missed opportunities for therapy.

CRD42023492433.

Glucosamine is a commonly used ‘over the counter’ dietary supplement. Previous research has identified an association between glucosamine use and several positive health outcomes. However, a plausible biological mechanism for these associations has not yet been identified, meaning the causality of these relationships remains unclear. A protective effect of glucosamine on the vascular endothelium has been suggested as one such possible mechanism. Albuminuria is an early marker of endothelial dysfunction within the kidney and is associated with progression of kidney disease and adverse cardiovascular outcomes. In order to provide insights into the potential biological mechanisms underlying a protective association of glucosamine use with health outcomes, we evaluated evidence for an association between glucosamine use and albuminuria in UK Biobank (N=436 200).

Univariable and multivariable ordinal logistic regression were performed to evaluate evidence for an association between self-reported glucosamine use and albuminuria (measured as urine albumin creatinine ratio (uACR) categories). As a secondary analysis, we performed Mendelian randomisation (MR) to demonstrate the difficulties in inferring causality in this relationship using currently available data, using summary genetic data from UK Biobank and CDKGen (N=67 452).

We found that people who used glucosamine were more likely to be in a lower uACR group (OR 0.81, 95% CI 0.80 to 0.83, px10^–16). This association was robust to sensitivity analyses and was maintained after adjustment for age, sex and measures of obesity. In our MR analysis, we found little evidence for an association of genetically proxied glucosamine use on albuminuria (change in log uACR (mg/g) per SD change in genetic liability=1.11, 95% CI –3.01 to 5.23, p=0.60).

We found that detectable albuminuria was common in UK Biobank participants and we are the first to show that use of glucosamine supplements was associated with lower levels. Though this fits with a plausible biological role of the vascular endothelium in a potential protective effect of glucosamine use on many health outcomes, whether this relationship is causal or confounded remains unclear. We further discuss the inherent difficulties in using genetic instruments to proxy supplement use in MR analyses and highlight the need for a genome-wide association study of measured circulating glucosamine levels.

Haemodialysis (HD) is an essential treatment for end-stage renal disease patients to improve their quality of life. However, conventional HD may not effectively remove medium and large molecules and protein-bound toxins, leading to the occurrence of various complications. Haemoadsorption (HA), on the other hand, can address this limitation. Therefore, a multicentre, open-label, randomised, parallel controlled study will be conducted to compare HA combined with HD (HAHD) with HD alone in maintenance haemodialysis (MHD) patients. The primary endpoint is the change in serum β2-MG, PTH and CRP values.

We plan to enrol 410 MHD patients from 10 participating medical centres in Shanghai. Patients will experience a 4-week washout period and a 52-week observation period. After the washout period, the eligible patients will be randomised in a 1:1 ratio to the two groups: the control group, 3 times/week conventional HD treatment; and the experiment group, 3 times/week conventional HD treatment+1 time/week HA treatment. The baseline and follow-up data at 0, 4, 12, 24, 36 and 52 weeks were collected from both groups, including the following: medical history, routine physical examination, dialysis regimen, laboratory tests, dialysis adequacy as defined by standard Kt/V, chest X-ray, ECG, cardiac ultrasound and three scales. Comorbidities, combined medications and adverse events will also be captured. The primary outcomes will include change in serum β2-MG, PTH and CRP values. Secondary outcomes will include change values for serum protein-bound toxins, improvement in patient quality of life, sleep disturbance and pruritus.

The protocol has been approved by the Ethics Committees of 10 participating medical centres. Shanghai Changhai Hospital Ethics Committee will oversee the study. The results will be presented at national and international academic meetings, and publications will be submitted to peer-reviewed journals.

NCT05639010.

To externally validate and subsequently repurpose/recalibrate the easily accessible kidney failure risk equation (KFRE) for a prevalent transplant population with an estimated glomerular filtration rate (eGFR)

Retrospective cohort study using UK Renal Registry data.

68 adult UK kidney centres.

4092 patients with grafts at least 2 years old and eGFR2 from 2009 to 2018.

Death-censored allograft failure at 2 years, defined as dialysis initiation, re-transplantation or, in the absence of the former two, the recorded date of transplant failure.

The KFRE was calculated at baseline using the 2-year, 8-variable non-North American KFRE, and performance was assessed using Harrell’s C-statistic and calibration plots. The model was recalibrated using Cox Regression (2009–2013 cohort) and temporally validated using the 2014–2018 cohort. Clinical utility was assessed using decision-curve analysis, estimating per-100-patient gains in timely planning and reductions in unnecessary interventions compared with eGFR triggers.

The original KFRE had excellent discrimination but was miscalibrated, underpredicting graft failure. Temporal validation demonstrated that the performance of the recalibrated KFRE could be maintained across time periods (Harrell’s C-index of 0.81 (95% CI 0.80 to 0.83); O/E (Observed/Expected events) ratio 1.00 (95% CI 0.93 to 1.07). It identified 9/100 more patients for timely intervention and 13/100 more for whom intervention could be delayed compared with a late clinical trigger of an eGFR2.

While there are other prognostic models, this is the first study to focus on the understudied and clinically important cohort of patients with an eGFR

To determine progression in adult patients with early-stage chronic kidney disease (CKD) attending tertiary hospitals in Dodoma, Tanzania.

Prospective longitudinal study.

This study was conducted in two tertiary hospitals in Dodoma, Tanzania.

The population in this study was adult patients aged ≥18 years with early-stage CKD who were attending nephrology and medical outpatient clinics at Benjamin Mkapa Hospital and Dodoma Regional Referral Hospital, which are tertiary hospitals in Dodoma, Tanzania, from November 2020 to March 2022. Inclusion criteria included: patients aged ≥18 years of age, attending the clinic for at least 3 months with baseline clinical data on their files, estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m² and who gave a written informed consent. A total of 352 patients were enrolled, of whom 182 were males and 170 were females.

The dependent variable in this study was CKD progression, which was assessed after 12 months of follow-up.

A total of 352 participants with a median age of 54 (47–59) years were enrolled; the prevalence of progression of early-stage CKD was 28.0% (97/346). For patients with CKD progression, the baseline median eGFR was 43 (41–49) mL/min/1.73 m², urine protein creatinine ratio was 0.099 (0.025–0.158) mg/g, and haemoglobin was 11.7 (9.7–12.6) g/L. Of the patients with CKD progression, 75.3% (73/97) had diabetes mellitus, 72.2% (70/97) of the patients had hypertension, 58.8% (57/97) of the patients had significant proteinuria, and 58.8% (57/97) of the patients had anaemia. Variables associated with CKD progression after multivariate logistic regression analysis were; diabetes mellitus (OR=7.02, 95% CI 3.01 to 16.39, p=0.001), use of local herbs (OR=27.98, 95% CI 11.08 to 70.70, p=0.001), anaemia (OR=2.49, 95% CI 1.32 to 4.68, p=0.005), proteinuria (OR=7.51, 95% CI 3.49 to 16.19 p=0.001). Half, 52.5% (51/97) of the patients with CKD progression were found to have left ventricular hypertrophy (LVH), 26.8% (26/97) of the patients had evidence of coronary artery disease (CAD) on non-invasive testing, and 11.3% (11/97) of the patients died during the study period.

A substantial portion of adult patients with early-stage CKD were found to have progression after 12 months of follow-up. Diabetes mellitus, proteinuria, anaemia and use of local herbal medicines were significant predictors for CKD progression. Of the patients with CKD progression, more than half of the patients were found to have LVH, almost one third of the patients had evidence of CAD on non-invasive testing, and few patients died.

Chronic kidney disease (CKD) affects 1 in 10 people worldwide and can progress towards kidney failure, which is best predicted by the severity of kidney fibrosis. Currently, kidney fibrosis can only be detected by invasive kidney biopsy which carries procedural risks with limitations on repeat testing. MRI techniques have emerged as potential surrogate markers for kidney fibrosis, though data remain limited. To date, no studies have examined postgadolinium contrast T1 mapping in kidney fibrosis despite its proven utility in assessing myocardial fibrosis. This study aims to develop a multiparametric MRI biomarker including postcontrast imaging to quantify kidney fibrosis in individuals with CKD.

In this observational cohort study, a control group of 20 healthy adult volunteers will establish healthy kidney MRI parameters. Two adult non-dialysis CKD cohorts (each n=24) who have undergone kidney biopsy within the last month will derive and validate the MRI models, respectively. Tubulointerstitial fibrosis on kidney biopsy will be assessed by Masson trichrome staining and quantified based on the percentage of cortex affected by blinded pathologists. All participants will undergo a single multiparametric kidney MRI including kidney volumetry, T1 mapping (pre-low-dose and post-low-dose contrast), T2 mapping, T2* mapping, diffusion weighted imaging and phase-contrast MRI of renal artery flow. The primary outcome will be the association between a composite multiparametric MRI marker and tubulointerstitial fibrosis with a minimum variance of 50%. The association between the multiparametric MRI marker and individual MRI variables, and tubulointerstitial fibrosis, estimated glomerular filtration rate and albuminuria will also be studied.

Ethics approval has been obtained by the Northern Sydney Local Health District Human Research Ethics Committee (2022/ETH00972). Results will be disseminated in relevant peer-reviewed journals and presented at academic conferences.

ACTRN12622000855729p (Pre-results).

Frequent haemodialysis creates close-knit communities within treatment units, where high patient mortality contributes to significant grief among patients and staff. Despite the emotional toll, support for grief and bereavement in these settings remains limited, and recent data are lacking. This scoping review aims to explore how patients and nursing staff within haemodialysis units experience and cope with bereavement, and to identify support strategies currently used or desired to inform future, culturally sensitive approaches, particularly in Australia.

Scoping review conducted in accordance with the Joanna Briggs Institute methodology.

A comprehensive search was conducted using the Clinical Information Access Portal, supplemented by grey literature and the Elicit AI Research Assistant tool.

We included literature exploring patient and nurse perspectives on grief and bereavement in haemodialysis units. Studies outside the haemodialysis setting and non-English studies were excluded. There were no geographical or publication year limitations.

Two reviewers independently screened titles, abstracts and full texts, with discrepancies resolved by consensus. A data extraction table was used to collect study characteristics and key findings. Thematic analysis was applied to synthesise data across studies.

17 publications from 1998 to 2021 were identified across five countries. Grief and bereavement following patient death profoundly shape haemodialysis unit dynamics. Patients form familial bonds and experience deep grief when peers die, while nurses face emotional stress and burnout. Reported support strategies include memorial services, peer and staff support, counselling and debriefing and spiritual care.

This study describes grief experiences, support strategies and cultural implications in haemodialysis units, which serve a culturally diverse group of people. By consolidating available knowledge, this review provides a critical platform for future empirical work and calls for culturally sensitive support and larger, diverse samples in future research.